I have successfully scheduled an appointment to meet with a psychiatrist tomorrow morning. I made an appointment earlier this week to meet with my college school counsellor, which I visited today.

After two hours of spilling my guts I have found a sense of release. I am looking forward to seeking Cognitive Behavioral Therapy (CBT) with him, since he's right on campus. Great guy.

I told him my main reason for the visit was to figure out what to expect from my psychiatrist appointment tomorrow.

Since I am planning on doing Counsel Therapy through him, it would be unnecessary to seek therapy from my psychiatrist who is about a 2 hour commute.

Being thorough and honest with me, he brought up the big M word that I should look to discuss with my psychiatrist. Medication.

It is a sore subject to speak about but I have nothing to hide and nothing to mask as I am looking to be responsible from the start if medication is the path I want to take.

Since I am the one seeking help it would be inappropriate to tell my psychiatrist what I need and do not need. But I was looking to connect with a few of you.

Counselor mentioned that a Short-Term "As-Needed" medication may be suitable to work side by side with my CBT therapy.

This questions me as to...

What happens if my psychiatrist prescribes me a long term (build up in your system) SSRI?

I don't want something that is taken daily long term,

I want something that I can take as needed, short term, to assists in Therapy.

Can I request that my psychiatrist/or counselor can monitor my intake? I would be all for signing an agreement or doing call ins, I don't think I will have an issue but I want to cover my bases.

My counselor, granted he is not a medical doctor, suggested that the psychiatrist can prescribe something along the lines of a lorazepam and/or something to help stay focused in classes while I work out my anxiety/perceptual issues.

Bottom line I don't want an SSRI, I'm not depressed,

And I don't want something that will be required to be taken if I'm not in direct need.

I want something that I can take as needed, short term, to assists in Therapy.

The benzodiazepines are ideal for occasional use as needed, say 2-3 times a week at most, but they are not good meds if you need to take them daily for more than a month or so. The problem isn't so much the meds, but the increasing unwillingness of doctors to prescribe them long term because of the perceived dependency issue. It is mostly nonsense as dependency is also an issue with antidepressants, even sometimes therapy, but nevertheless this is the way it is.

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Bottom line I don't want an SSRI, I'm not depressed,

SSRIs are actually slightly better anxiety than depression meds. Both anxiety and depression are caused by the same brain deficits and are just differing expressions of the same biology. In both cases the disorder resolves as the antidepressant triggers growth of new brain cells in the hippocampal regions of the brain.

NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

I'm kind of bouncing around with the whole benzodiazepine speel because as you said, there are limitations on them and how often to take them. I figured they would be good to have in case I have an episode.

So let's say I have been put on with an SSRI, can I request and/or safely cycle both an SSRI and a "as-needed" medication if the case may be she wants to peddle Zoloft or something?

I appreciate your time, I just want to go in there with the right open mind, not to tell her what to do, but to understand what my options are.

As I think that you are already well aware, a psychiatrist is a medical doctor. Being medical doctors, most of them are no longer involved in the old fashion "couch" therapy sessions. After an intake interview, my lasted an hour and 20 minutes, a psychiatrist can provide you with an actual diagnosis, they can write prescriptions for appropriate medications, and also design a treatment plan, specific for your needs.

One thing that your psychiatrist will take into consideration is your history. Mine indicted a history of mild anxiety problems that became more severe some four years ago. With this to consider, I was started on an anti-depressant, and plan on being on one the rest of my life.

I don't take "as-needed" medications such as the benzodiazapines, but you can be on an anti-depressant, such as an SSRI, and still have a "whenever necessary" medication, such as the benzodiazapines, for when things get a little stressful.

Do keep an open mind when you see your psychiatrist tomorrow. They have trained long and hard to provide you with an appropriate route of treatment.

So let's say I have been put on with an SSRI, can I request and/or safely cycle both an SSRI and a "as-needed" medication if the case may be she wants to peddle Zoloft or something?

Sure, though hopefully CBT and/or an antidepressant will work so well that you won't need anything else, however, having one of the benzodiazepines available to help with the anxiety spike that antidepressants may produce in the first few weeks can make life much easier. If the psychiatrist won't prescribe BZDs, then ask for hydroxyzine, a antihistamine with some anti anxiety properties.

NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

When one starts on an anti-depressant in the selective serotonin reuptake inhibitor class (SSRI), serotonin levels are immediately increased. This is what produces the side effects that are experience by some. Side effects can include a temporary increase in anxiety. Most serotonin actually exist in the digestive system, so some individuals may experience gastrointestinal disturbances such as nausea and diarrhea.

To reduce the chances of side effects, it is a good idea to start taking a SSRI at a sub-therapeutic dose. This might also aid in keeping anxiety at the baseline prior to starting the anti-depressant. To give you an example: Celexa's lowest therapeutic dose is 20 mg. When starting this medication, one can begin at 5 mg for a 7-10 day period, when increase to 10 mg, when 15 mg, and finally 20 mg. With every increase in dosage, one might see a return of side effects, but these are usually short lived.

It is not uncommon at all for a psychiatrist to prescribe a benzodiazapine when one is starting on an anti-depressant, but that depends on the doctor.

Good luck with your appointment tomorrow! Let us know how things come out.

Not to sound repetitious, but is it common for a psychiatrist to prescribe Benzos or medicines of such to edge start up symptoms?

Not as common as it should be, IMHO.

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It seems that everyone I've read about who has started up an SSRI were experiencing some serious repercussions (diarrhea, upset stomach, fatigue)

Not everyone experiences severe side-effects, indeed some have none, so you may not either. Benzodiazepines won't help with the ones you've listed, but starting on a low antidepressant dose and increasing it by similar small amounts every 7-10 days (longer for Prozac) can render them tolerable.

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Due to the severity of my case I don't see my symptoms spiking anywhere out of the norm, but do SSRIs initially potentiate the symptoms of anxiety?

They often do. Initially, antidepressants increase serotonin activity which is what produces most of the side-effects, including a spike in anxiety. Fortunately, the body adapts to this after a few weeks and the symptoms diminish, but they may return whenever the dose is increased.

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It's weird, they did not require a pre-evaluation from a General Practioner.

Have you had a full physical including bloods to check that your symptoms aren't being caused by organic disease? If not, you should insist on this being done. Never accept an anxiety diagnosis unless other causes have been first ruled out. In most cases it is an anxiety disorder, but there are a few diseases which can produce the same symptoms.

NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

At first she was very stern and in a way intimidating "are you here for medication?"

I told her "No, I am here to seek professional help, I'm unsure of what I want to do and I'm seeking more information."

I mentioned I have scheduled to participate in CBT locally, I signed a release of information.

She softened up as things went on, I even got to the point of breaking down, crying, I had felt she understood me and an emotional wave went through me like pulling a drain stop.

My heart rate was 164/100 and pulse at about 90, not sure if the Diastolic is correct but I think so.

She became very helpful and I was given the feeling of trust and honest help.

She was happy to hear my college plans and my interest in attending Therapy, even said medication WITH therapy is more effective that going without.

She has gotten me on a Zoloft plan, I questioned about the sub therapeutic dosage, and she said that's what I'll do for the first week.

She paired it with Klonopin to ease any anxiety spikes, I plan on taking it as needed but she still insisted twice daily, and prescribed me that amount, I will probably do this as follows until I hear from her further on if it can be taken as needed.

She also told me not to be afraid to ask her to fluctuate the dosage of the benzodiazepine and that it is better to find the comfortable and optimal dosage.

I'll start the Zoloft tomorrow, I am already optimistic.

Diagnosed me pretty heavy in Social Anxiety and very minor acute PTSD. I have scheduled follow ups and told her I would keep in contact.

Thank you all for your help and advice, if you have any pointers of opinion, feel free to let me know.

NOTE: I'm not a doctor, and particularly not yours, so there may be factors I'm unaware of. Therefore all advice is of a general nature and you should consult your doctor before following any of it, especially before changing med doses.

I was thinking about you throughout the day, and was glad to see your post this evening, about how things went. Sounds like they could not have gone better! I am glad that Ian, who is a most fantastic gentleman, and I could help you out.

I am curious as what dosage of Zoloft your psychiatrist is starting you on. Also, your blood pressure running 164/100 doesn't surprise me, as that is what mine usually runs when I'm face-to-face with a doctor.

She has started me off on 50mg of Zoloft ( ser-something) but for the first week she advised cutting the pills in half for a 25mg dose. With the Klonopin being .25mg 2x a day (splitting a .5mg).

I will have a follow up with her in two weeks and call in with her next week, and from there a follow up a couple months out.

The pharmacist insisted the Klonopin should be taken as need, but the psychiatrist firmly stated 2 doses daily, she was open about the fact that I will benefit and do better in my classes.

She wanted me to take a Klonopin today and start the cycle off tomorrow ( I was planning on starting both tomorrow) so I took .25 mg a few hours ago.

It's hard to tell what is placebo and what's not, about an hour after taking it I feel a mellow, calm state of mind, not like a "I'm high on drugs" persona (which I was afraid of since I'm in a college setting all day) but not many of my daily worries have really been itching at me. In fact I'm kind of sleepy.

This may be due to the fact that I have sought help and know I have a game plan set to get me back on track again.

I'm curious as to how well I will ride the initial take off of the SSRI, I don't have any intentions on increasing dosage of the benzo, so if I play it safe and take it as a mind control game I should be pretty set in stone. But I grew to respect the fact that she openly gave me the offer to contact her about dosages, though I won't take advantage of that.

I am so glad I could be of help to you. Post any questions that might come-up, and you are also welcome to send me a PM too. There are some really great people on the Anxiety Zone site, and I have made what I am sure, some lifelong friends.

From what you described, those are the effects of the Klonopin. The results from that medication are pretty instantaneous; it's to bad that anti-depressants aren't, but they don't work the same way.

Hope you get a good night's sleep. Looking forward to seeing how things go for you. You have got a great, positive attitude, so I am knowing that things are going to go well.